Common ENT emergencies

37,549 views

Published on

Published in: Health & Medicine
4 Comments
64 Likes
Statistics
Notes
  • wonderfull summary
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • http://www.fioricetsupply.com is the place to resolve the price problem. Buy now and make a deal for you.
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • horrible!!
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • superb
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total views
37,549
On SlideShare
0
From Embeds
0
Number of Embeds
801
Actions
Shares
0
Downloads
2,682
Comments
4
Likes
64
Embeds 0
No embeds

No notes for slide

Common ENT emergencies

  1. 1. COMMON ENT EMERGENCIES Thongchai Luxameechanporn ENT department Ramathibodi hospital
  2. 2. Common ENT emergencies <ul><li>Foreign bodies </li></ul><ul><li>Trauma </li></ul><ul><li>Complications of ENT infections </li></ul>
  3. 3. ear
  4. 4. Foreign bodies <ul><li>Insects </li></ul><ul><li>Cotton, paper, organic material </li></ul><ul><li>Small batteries </li></ul><ul><li>Discomfort & agitation </li></ul><ul><li>Secondary complications: infection & mucosal erosion </li></ul>
  5. 5. Foreign bodies <ul><li>Kill any live insects </li></ul><ul><li>Remove foreign body with micro alligator forceps </li></ul><ul><li>Irrigation ( do not use if organic FB ) </li></ul>
  6. 6. Auricular Hematoma <ul><li>Usually from trauma </li></ul><ul><li>Fluctuant bluish swelling of auricle </li></ul><ul><li>Drainage </li></ul><ul><li>- Needle aspiration </li></ul><ul><li>- I & D </li></ul><ul><li>Apply compression dressing </li></ul>
  7. 7. Traumatic TM Perforation <ul><li>Compression, instrumentation & </li></ul><ul><li>blast injuries </li></ul><ul><li>Hearing test </li></ul><ul><li>Close observation if perforation is small </li></ul><ul><li>Paper patch </li></ul><ul><li>Surgery </li></ul>
  8. 8. Temporal bone fracture <ul><li>Blunt head injury </li></ul><ul><li>Longitudinal Fx -> facial n. paralysis, CHL (ossicular chain disruption) </li></ul><ul><li>Transverse Fx -> SNHL, dysequilibrium, CN VII palsy </li></ul>
  9. 9. Temporal bone fracture <ul><li>Battle’s sign (bluish discoloration of postauricular region), raccoon eyes, hemotympanum, hearing loss, dizziness, CSF otorrhea, CN VII palsy </li></ul><ul><li>CT temporal bone </li></ul>
  10. 10. Acoustic trauma <ul><li>Sudden exposure (impact or blast) to noise </li></ul><ul><li>SHNL, tinnitus </li></ul><ul><li>Avoidance/ ear protection </li></ul><ul><li>Corticosteroids, carbogen, vasodilators, diuretics, anticoagulants, plasma expanders </li></ul>
  11. 11. Otitic Barotrauma <ul><li>Inability to ventilate middle ear -> abnormal dysfunction of ET </li></ul><ul><li>Occur in rising ambient pressure (descent in flight / scuba diving) </li></ul><ul><li>Can produce hemotympanum </li></ul>
  12. 12. Barotrauma <ul><li>Repeated Valsalva maneuver </li></ul><ul><li>Topical nasal decongestants </li></ul><ul><li>Myringotomy & PE tube insertion may be needed </li></ul>
  13. 13. Sudden Hearing Loss <ul><li>SNHL ≥ 30 dB over 3 contiguous frequencies within 3 days or less </li></ul><ul><li>Etiology : Viral & Infectious, Vascular, Trauma, Autoimmune, Neurologic </li></ul>
  14. 14. Complications of ME infections <ul><li>Extracranial </li></ul>
  15. 15. Acute Mastoiditis <ul><li>preceded by AOM </li></ul><ul><li>young children </li></ul><ul><li>severe pain, fever, edema </li></ul><ul><li>over mastoid area </li></ul><ul><li>intravenous ATB </li></ul><ul><li>Myringotomy ± PE tube </li></ul>
  16. 16. Subperiosteal Abscess <ul><li>pinna pushed </li></ul><ul><li>down & outward </li></ul><ul><li>intravenous ATB </li></ul><ul><li>I&D </li></ul><ul><li>mastoidectomy </li></ul>
  17. 17. Complications of ME infections <ul><li>Intracranial </li></ul>
  18. 18. nose
  19. 19. Foreign bodies: Symptoms <ul><li>Purulent unilateral nasal discharge </li></ul><ul><li>Usually lodge on the floor of anterior or middle third </li></ul>
  20. 20. Foreign bodies: Management <ul><li>Good visualization: headlamp & nasal speculum </li></ul><ul><li>Alligator forceps should be used to remove cloth, cotton, or paper </li></ul><ul><li>Other hard FB are more easily grasped using bayonet forceps or Kelly clamps, or they may be rolled out by getting behind it using an ear curette, single skin hook, or right angle ear hook </li></ul>
  21. 21. Nasal Fracture <ul><li>Hx of fall or force directed to midface </li></ul><ul><li>Deformity of nose </li></ul><ul><li>Swelling, ecchymosis, epistaxis </li></ul><ul><li>Close or open reduction </li></ul>
  22. 22. Septal hematoma/abscess <ul><li>Trauma, surgery </li></ul><ul><li>Soft, fluctuant swelling of septum </li></ul><ul><li>Needle a spiration </li></ul><ul><li>or I&D </li></ul><ul><li>Bilateral nasal packing for several days </li></ul><ul><li>Prophylactic antibiotics </li></ul>
  23. 23. Septal hematoma/abscess
  24. 24. Epistaxis <ul><li>Local </li></ul><ul><li>Trauma /Nose picking or blowing / surgery </li></ul><ul><li>Dry air / Irritants </li></ul><ul><li>Topical medications (steroids) </li></ul><ul><li>Foreign body </li></ul><ul><li>Tumor / polyp </li></ul><ul><li>Systemic </li></ul><ul><li>Blood diseases </li></ul><ul><li>Hereditary hemorrhagic telangiectasia </li></ul><ul><li>Drugs (anticoagulants) </li></ul><ul><li>Hypertension </li></ul>
  25. 25. Epistaxis
  26. 26. Epistaxis <ul><li>Initial first-aid </li></ul><ul><li>Assessment of blood loss </li></ul><ul><li>Evaluation of cause </li></ul><ul><li>Procedure to stop bleeding </li></ul><ul><li>Most common -> Kiesselbach’s Plexus </li></ul><ul><li>Squeeze nose 5-20 mins </li></ul><ul><li>Insert cotton pledget (with decongestant) </li></ul><ul><li>Cautery with silver nitrate </li></ul>
  27. 27. Pope, L E R et al. Postgrad Med J 2005;81:309-314 Figure 1 Epistaxis management protocol.
  28. 28. Epistaxis
  29. 29. Anterior nasal packing <ul><li>Local anesthetic & decongestant </li></ul><ul><li>Nasal packing </li></ul><ul><li>- Vasaline guaze </li></ul><ul><li>- Absorbable gelfoam </li></ul><ul><li>- Oxidized cellulose </li></ul><ul><li>(Surgicel) </li></ul><ul><li>- Nasal tampon </li></ul>
  30. 30. Anterior nasal packing
  31. 31. Anterior nasal packing <ul><li>Nasal packing </li></ul><ul><li>- Vasaline guaze </li></ul><ul><li>- Absorbable gelfoam </li></ul><ul><li>- Oxidized cellulose </li></ul><ul><li>(Surgicel) </li></ul><ul><li>- Nasal tampon </li></ul>
  32. 32. Anterior nasal packing <ul><li>Nasal packing </li></ul><ul><li>- Vasaline guaze </li></ul><ul><li>- Absorbable gelfoam </li></ul><ul><li>- Oxidized cellulose </li></ul><ul><li>(Surgicel) </li></ul><ul><li>- Nasal tampon </li></ul>
  33. 33. Anterior nasal packing <ul><li>Nasal packing </li></ul><ul><li>- Vasaline guaze </li></ul><ul><li>- Absorbable gelfoam </li></ul><ul><li>- Oxidized cellulose </li></ul><ul><li>(Surgicel) </li></ul><ul><li>- Nasal tampon </li></ul>
  34. 34. Copyright ©2005 BMJ Publishing Group Ltd. Pope, L E R et al. Postgrad Med J 2005;81:309-314 Figure 2 Correct insertion of a nasal tampon (note that the direction is along the floor of the nasal cavity).
  35. 35. Posterior nasal packing <ul><li>Topical anesthetic & decongestant </li></ul><ul><li>Posterior nasal packing </li></ul><ul><li>Double balloon device </li></ul><ul><li>Foley catheter </li></ul>
  36. 36. Posterior nasal packing <ul><li>Topical anesthetic & decongestant </li></ul><ul><li>Posterior nasal packing </li></ul><ul><li>Double balloon device </li></ul><ul><li>Foley catheter </li></ul>
  37. 37. Posterior nasal packing <ul><li>Topical anesthetic & decongestant </li></ul><ul><li>Posterior nasal packing </li></ul><ul><li>Double balloon device </li></ul><ul><li>Foley catheter </li></ul>
  38. 38. Complications of sinusitis <ul><li>Orbital complications </li></ul><ul><li>Intracranial complications </li></ul>
  39. 39. Classification of orbital inflammation <ul><li>Stage </li></ul><ul><li>I </li></ul><ul><li>II </li></ul><ul><li>III </li></ul><ul><li>IV </li></ul><ul><li>V </li></ul><ul><li>Inflammation </li></ul><ul><li>Inflammatory edema </li></ul><ul><li>(periorbital cellulitis) </li></ul><ul><li>Orbital cellulitis </li></ul><ul><li>Subperiosteal abscess </li></ul><ul><li>Orbital abscess </li></ul><ul><li>Cavernous sinus thrombosis </li></ul>
  40. 40. Complications of sinusitis <ul><li>Periorbital cellulitis: periorbital erythema, edema, pain & fever </li></ul><ul><li>Purulent nasal discharge </li></ul><ul><li>S.pneumoniae, S.aureus, coagulase-negative staphylococci </li></ul><ul><li>Broad-speculum antibiotics </li></ul>
  41. 41. Complications of sinusitis <ul><li>Orbital complications (stages II-V) </li></ul><ul><li>Periorbital swelling & pain, fever </li></ul><ul><li>Proptosis, chemosis, restriction of ocular movement & visual disturbance </li></ul>
  42. 42. Complications of sinusitis <ul><li>CT scan -> subperiosteal & orbital abscess </li></ul><ul><li>Admission & IV broad- spectrum antibiotics </li></ul><ul><li>Surgery (drainage) if </li></ul><ul><li>- failed medication </li></ul><ul><li>- develop abscess </li></ul><ul><li>- visual drop </li></ul>
  43. 43. Complications of sinusitis <ul><li>Intracranial complications </li></ul><ul><li>Cavernous sinus thrombosis, meningitis, extradural abscess, intracranial abscess & subdural empyema </li></ul><ul><li>Purulent rhinorrhea, fever, frontal/retro-orbital headache </li></ul><ul><li>Personality change/lethargy, seizures, N/V, focal neurological deficits </li></ul>
  44. 44. Complications of sinusitis <ul><li>Intracranial complications </li></ul><ul><li>Diagnosis -> MRI scan with gadolinium </li></ul><ul><li>Admission, IV broad-spectrum antibiotics & surgical drainage </li></ul>
  45. 45. throat
  46. 46. Swallowed foreign body <ul><li>Peanuts, coins, batteries, fish bone, meat & bone pieces, dentures </li></ul><ul><li>Location of pain indicates FB location </li></ul>
  47. 47. Swallowed foreign body <ul><li>Fish bones tend to lodge in oropharynx, produced ipsilateral symptoms </li></ul><ul><li>Esophagus FB localize in midline: dramatic acute dysphagia </li></ul>
  48. 48. Swallowed Foreign bodies <ul><li>Most FB in oropharynx can be identified </li></ul><ul><li>Esophageal FB: pooling of saliva in piriform </li></ul><ul><li>X-rays may be helpful in radio-paque objects </li></ul>
  49. 49. Swallowed Foreign bodies <ul><li>Visualized FB can be removed with angled forceps </li></ul><ul><li>Sharp FB should be removed at the earliest opportunity due to risk of perforation </li></ul>
  50. 50. Swallowed Foreign bodies <ul><li>Coins -> removed if in cervical or mid esophagus -> removed within 12 hrs if in distal esophagus </li></ul><ul><li>Batteries -> removed emergency </li></ul>
  51. 51. Swallowed Foreign bodies <ul><li>Airway compromise </li></ul><ul><li>- Heimlich maneuver </li></ul><ul><li>- Emergency </li></ul><ul><li>cricothyrotomy/ </li></ul><ul><li>tracheostomy </li></ul><ul><li>Endoscopy with removal in OR </li></ul>
  52. 52. Inhaled Foreign bodies <ul><li>Sudden onset of coughing, wheezing or stridor in previously healthy child </li></ul><ul><li>Unilateral wheezing, poor chest movement & reduced breath sound </li></ul><ul><li>CXR: hyperinflate, infection, collapse </li></ul>
  53. 53. Inhaled Foreign bodies <ul><li>Heimlich manuver </li></ul><ul><li>Secure airway </li></ul><ul><li>Endoscopic removal under general anesthesia </li></ul>
  54. 54. Airway Obstruction <ul><li>Neonatal : Congenital tumors, cysts, webs </li></ul><ul><li>: Laryngomalacia </li></ul><ul><li>: Subglottic stenosis </li></ul><ul><li>Children : Laryngotracheobronchitis </li></ul><ul><li>: Supraglottitis (epiglottitis) </li></ul><ul><li>: Foreign body </li></ul><ul><li>: Retropharyngeal abscess </li></ul><ul><li>: Respiratory papilloma </li></ul><ul><li>Adults : Laryngeal cancer </li></ul><ul><li>: Laryngeal trauma </li></ul><ul><li>: Epiglottis & deep neck infection </li></ul>
  55. 55. Deep neck infections
  56. 56. Peritonsillar abscess <ul><li>Pus forms between tonsils capsule & superior constrictor </li></ul><ul><li>Group A Streptococcus </li></ul>
  57. 57. Peritonsillar abscess <ul><li>Severe, unilateral sore throat </li></ul><ul><li>fever </li></ul><ul><li>Hot potato voice </li></ul><ul><li>Uvula deviates to opposite side </li></ul><ul><li>Swollen tonsils </li></ul>
  58. 58. Peritonsillar abscess <ul><li>CBC, throat C/S </li></ul><ul><li>Antibiotics </li></ul><ul><li>- Oral </li></ul><ul><li>- Parenteral </li></ul><ul><li>needle aspiration or I&D </li></ul>
  59. 59. Ludwig’s Angina <ul><li>Rapid swelling cellulitis of sublingual & submaxillary spaces </li></ul><ul><li>Dental infection, floor of mouth, salivary gland </li></ul><ul><li>Fever, edema & erythema of neck under chin & floor of mouth </li></ul>
  60. 60. Ludwig’s Angina <ul><li>Open mouth, </li></ul><ul><li>Tongue -> upward & backward -> airway obstruction </li></ul><ul><li>Streptococci, Bacteroides, S.aerues </li></ul><ul><li>Tracheostomy </li></ul><ul><li>IV antibiotic </li></ul><ul><li>I&D, tooth extraction </li></ul>
  61. 61. Epiglottitis <ul><li>Age 3-7 yrs old </li></ul><ul><li>H. influenzae type B, Group A Streptococcus </li></ul><ul><li>severe sore throat & fever, dysphagia, drooling </li></ul><ul><li>Stridor </li></ul><ul><li>Breathing with raised chin & open mouth </li></ul>
  62. 62. Epiglottitis <ul><li>CBC: leukocytosis </li></ul><ul><li>Film lateral neck -> thumb shaped epiglottis </li></ul><ul><li>Avoid tongue depressor </li></ul><ul><li>Controlled intubation </li></ul><ul><li>Intravenous ATB </li></ul>
  63. 63. Retropharyngeal Abscess <ul><li>Infants & children </li></ul><ul><li>Secondary to oropharyngeal infection </li></ul><ul><li>Severe dysphagia & respiratory distress </li></ul><ul><li>airway observation </li></ul><ul><li>IV antibiotic </li></ul><ul><li>Surgical drainage </li></ul><ul><li>( prevent pus aspiration) </li></ul>
  64. 64. Tracheostomy <ul><li>Emergency tracheostomy </li></ul><ul><li>in the case of upper airways obstruction </li></ul><ul><li>1. Tumor in the larynx </li></ul><ul><li>2. Trauma of the larynx </li></ul><ul><li>3. Bilateral vocal cord paralysis </li></ul><ul><li>4. F.B. in the larynx after failure of Heimlich’s manuver </li></ul>

×